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Based on document reviews and interviews, the hospital was unable to follow their policy and provide a medical screening examination with the capability of the hospital's Emergency Department for a patient who was seeking care in one (1) of twenty (20) ED patient records reviewed (Patient #1).

Finding:

The hospital's "Management of Patients Presenting with Potential Emergency Medical Conditions in Compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) and Maine's Hospital Licensing Rules" policy, last revised 11/22, states in part, " ... If a person, including a minor, comes or presents to a MGMC ED ("ED") (i.e. at either the ACH, or the TCH) and (i) the person requests examination or treatment for a medical condition, (ii) a request for examination or treatment for a medical condition is made on the person's behalf by anyone accompanying the person, or (iii) it is evident to a prudent layperson observer that based on the person's appearance or behavior the person needs examination or treatment for a medical condition, qualified ED clinical staff (as defined in Section III(A)(2) below) shall provide an appropriate medical screening examination within the capability of the ED, including ancillary services routinely available to the ED, to determine whether an emergency medical condition exists. If a patient comes to a MGMC ED and a request is made on the patient's behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, qualified ED clinical staff will perform a medical screening examination medically appropriate for a patient presenting in that manner to determine that the patient does not have an emergency medical condition ... ".

On 12/07/2023, MaineGeneral Medical Center self-reported a possible EMTALA violation stating, in part, "[Patient #1] came into the Emergency Department to be seen for a "miscarriage". The registrar told the patient that because she was a minor, consent by a parent would be needed. The patient said that she did not want to contact the parent(s) and left the building. The registrar did NOT tell the patient that she could not be seen or treated."

On 01/03/2024 at 12:35 PM, the patient registration employee who was involved with Patient #1 on 12/05/2023 was interviewed. She stated that [Patient #1] came in and said she was possibly having a miscarriage, I usually ask their age ... she told me she was seventeen (17) years old and I told her we need consent. At that point, I didn't know her name. She said no and walked out. I offered her a nurse and she walked out."

MaineGeneral Medical Center identified the potential violation, self-reported the event, and put in measures to ensure that registration staff did not pose a question that could possibly deter a patient in the future from seeking care, which included a review of facility Emergency Medical Treatment and Active Labor Act ("EMTALA") policies, online EMTALA training for staff, and in-person EMTALA reviews with Emergency Department staff. At the time of the on-site survey, surveyors determined, through observation, document reviews, and interviews, that MaineGeneral Medical Center was in compliance, but previously out of compliance with 42 CFR, Part 489, Responsibilities of Medicare Participating Hospitals in Emergency Cases.

On 01/03/2024 at 10:56 AM, the Chief Compliance Officer was interviewed. She stated, in part, that the registration person was re-educated as she has only been here a few months. We have a new training for staff that may be exposed. It will be for anyone at the offsite practices, security and staff at the hospital and other campus'. All ED and Ob/Gyn staff have intensive EMTALA training.

Based on document reviews and interviews, the hospital was unable to provide a medical screening examination with the capability of the hospital's Emergency Department for a patient who was seeking care in one (1) of twenty (20) ED patient records reviewed (Patient #1).

Finding:

The hospitals "Management of Patients Presenting with Potential Emergency Medical Conditions in Compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) and Maine's Hospital Licensing Rules" policy, last revised 11/22, states in part, " ... If a person, including a minor, comes or presents to a MGMC ED ("ED") (i.e. at either the ACH, or the TCH) and (i) the person requests examination or treatment for a medical condition, (ii) a request for examination or treatment for a medical condition is made on the person's behalf by anyone accompanying the person, or (iii) it is evident to a prudent layperson observer that based on the person's appearance or behavior the person needs examination or treatment for a medical condition, qualified ED clinical staff (as defined in Section III(A)(2) below) shall provide an appropriate medical screening examination within the capability of the ED, including ancillary services routinely available to the ED, to determine whether an emergency medical condition exists. If a patient comes to a MGMC ED and a request is made on the patient's behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, qualified ED clinical staff will perform a medical screening examination medically appropriate for a patient presenting in that manner to determine that the patient does not have an emergency medical condition ... ".

On 12/07/2023, MaineGeneral Medical Center self-reported a possible EMTALA violation stating, in part, "[Patient #1] came into the Emergency Department to be seen for a "miscarriage". The registrar told the patient that because she was a minor, consent by a parent would be needed. The patient said that she did not want to contact the parent(s) and left the building. The registrar did NOT tell the patient that she could not be seen or treated."

On 01/03/2024 at 12:35 PM, the patient registration employee who was involved with Patient #1 on 12/05/2023 was interviewed. She stated that [Patient #1] came in and said she was possibly having a miscarriage, I usually ask their age ... she told me she was seventeen (17) years old and I told her we need consent. At that point, I didn't know her name. She said no and walked out. I offered her a nurse and she walked out."

MaineGeneral Medical Center identified the potential violation, self-reported the event, and put in measures to ensure that registration staff did not pose a question that could possibly deter a patient in the future from seeking care, which included a review of facility Emergency Medical Treatment and Active Labor Act ("EMTALA") policies, online EMTALA training for staff, and in-person EMTALA reviews with Emergency Department staff. At the time of the on-site survey, surveyors determined, through observation, document reviews, and interviews, that MaineGeneral Medical Center was in compliance, but previously out of compliance with 42 CFR, Part 489, Responsibilities of Medicare Participating Hospitals in Emergency Cases.

On 01/03/2024 at 10:56 AM, the Chief Compliance Officer was interviewed. She stated, in part, that the registration person was re-educated as she has only been here a few months. We have a new training for staff that may be exposed. It will be for anyone at the offsite practices, security and staff at the hospital and other campus'. All ED and Ob/Gyn staff have intensive EMTALA training.